Sebaceous Carcinoma of the Suprapubic Area in a Liver Transplant Recipient

Sebaceous carcinoma is a very rare and potentially aggressive carcinoma originating from the epithelial lining of the sebaceous gland. More than 70% of all cases are in the head and neck region, especially the periorbita; therefore, they are classified into ocular and extraocular sebaceous carcinoma. The reported risk factors are advanced age, male sex, previous irradiation, and genetic predisposition for Muir-Torre syndrome. The current case is of sebaceous carcinoma found in the suprapubic area of a 67-year-old male patient who had received liver transplantation 6 years before, and had been receiving oral tacrolimus. Examination of the gastrointestinal system did not reveal any other malignancies. Although nonmelanoma skin cancers may occur as a complication after liver transplantation, there have been no previous reports of sebaceous carcinoma after liver transplantation. Furthermore, the sebaceous carcinoma in this case occurred in an uncommon location. We report this case along with a review of the literature.

Virologic response to adefovir dipivoxil monotherapy is not durable in HBeAg-positive, lamivudine-resistant chronic hepatitis B patients / 대한간학회지

BACKGROUNDS/AIMS: It has been shown that adefovir dipivoxil is an effective antiviral agent in the treatment of chronic hepatitis B (CHB), not only in wild-type hepatitis B virus (HBV) infection, but also in lamivudine-resistant (LAMV-R) cases. However, little is known about the durability of the virologic response to adefovir in LAMV-R CHB patients. METHODS: Fifteen HBV e-antigen (HBeAg)-positive, LAMV-R CHB patients showed a virologic response to adefovir monotherapy. These patients received additional adefovir for at least a further 12 months. The virologic relapse rate after discontinuation of adefovir was evaluated. In addition, predictive factors associated with virologic relapse were investigated. RESULTS: The median level of serum HBV DNA before adefovir administration was 7,457,840 IU/mL (range 107,920-99,524,960 IU/mL). The median duration of adefovir treatment was 30 months (range 14-46 months). During a median follow-up period of 14 months after discontinuation of adefovir, the 1-, 2-, 3-, 6-, and 12-month cumulative relapse rates were 26.7%, 53.3%, 73.3%, 80%, and 80%, respectively. High pretreatment HBV DNA levels were found to be the only factor that was predictive of off-therapy relapse. CONCLUSIONS: Our data suggest that the adefovir-monotherapy-induced virologic response is not durable in most patients with LAMV-R HBeAg-positive CHB, especially in those with a high pretreatment HBV DNA level.

A Patient Diagnosed as Autoimmune Pancreatitis 6 Years after Onset of Jaundice / 대한소화기학회지

The clinical manifestations of autoimmune pancreatitis (AIP) are diffuse pancreatic swelling, diffuse irregular narrowing of the main pancreatic duct, and increased serum IgG or positive serum autoantibody. Clinically, AIP can be improved dramatically with oral steroid therapy. In this report, we describe a 62-year-old woman diagnosed as autoimmune pancreatitis six years after onset of jaundice, who presented with uncontrolled blood glucose levels. The laboratory tests revealed obstructive jaundice, and the computed tomography of the pancreas showed pancreatic swelling. After six years of onset, she was diagnosed with AIP and successfully treated with steroid treatment.

The Effect of Laughter Therapy on Sleep in the Community-dwelling Elderly / 가정의학회지

BACKGROUND: Aging process causes several changes in the typical sleep patterns. Elderly people complain frequently about sleep duration, changes of sleep/wake rhythm and day time sleepiness. This study was performed to evaluate improvement of sleep quality after laughter therapy. METHODS: On July 2007, the study participants aged over 65 were recruited through a community center in Daegu. There were 48 subjects in the experimental group and 61 in the control group. The laughter therapy program was applied to the experimental group. We compared Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) before and after laughter therapy. Data were analyzed by independent t-test, chi-square test, paired t-test, and ANCOVA using SPSS windows ver. 14.0. RESULTS: At initial study, there were no significant differences in baseline characteristics. The ISI scores were 8.00 +/- 6.29 and 8.36 +/- 6.38; the PSQI scores were 6.98 +/- 3.41 and 7.38 +/- 3.70; The Geriatric Depression Seals (GDS) scores were 7.98 +/- 3.58 and 8.08 +/- 3.95 in experimental and control groups, respectively. After laughter therapy, the ISI scores were 7.58 +/- 5.38 (P = 0.327) and 9.31 +/- 6.35 (P = 0.019), PSQI scores were 6.04 +/- 2.35 (P = 0.019) and 7.30 +/- 3.74 (P = 0.847), GDS scores were 6.94 +/- 3.19 (P = 0.027), 8.43 +/- 3.44 (P = 0.422) in experimental and control groups, respectively. CONCLUSION: The laughter therapy is considered to be useful for the elderly people in a community that improves insomnia and sleep quality.

A Case of Carcinosarcoma in the Liver / 대한소화기학회지

Primary hepatic carcinosarcoma which has comprised of a mixture of both carcinomatous and sarcomatous elements is very rare. This tumor has been variously called as carcinosarcoma, pleomorphic large cell carcinoma, giant cell carcinoma, or undifferentiated carcinoma. Only less than 20 cases of carcinosarcoma of the liver have been reported sporadically up to now worldwide. Herein, we present a case of carcinosarcoma of the liver along with a review of the literatures.

A case of Sweet syndrome involving small bowel / 대한내과학회지

Sweet syndrome is characterized by fever and abrupt appearance of painful, erythematous plaques: a dermal infiltrate of mature neutrophils. Extracutaneous manifestations often occur in Sweet syndrome, but intestinal involvement is extremely rare. We report a case of Sweet syndrome involving small bowel in a 56-year old male with fever and abdominal pain. An abdominal CT showed diffuse wall thickening in the ileal loop. He underwent explorative laparotomy and segmental resection of involved small bowel. Skin, bone marrow, and muscle biopsies were done because he had persistent fever, cutaneous plaques, pancytopenia, and swelling of lower extremities after operation. Finally, he was diagnosed as myelodysplastic syndrome combined with Sweet syndrome, which involved small bowel, skin, and muscle simultaneously. Fever, cutaneous plaques and leg swelling resolved after systemic administration of corticosteroids.

Comparative Efficacy and Safety of Cefepime alone Versus Ceftazidime Plus Tobramycin in Cancer Patients with Febrile Neutropenia / 감염과화학요법

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

Comparative Efficacy and Safety of Cefepime alone Versus Ceftazidime Plus Tobramycin in Cancer Patients with Febrile Neutropenia / 감염과화학요법

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

A Case of Plummer-Vinson Syndrome / 대한소화기내시경학회지

The combination of symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women constitutes Plummer-Vinson syndrome. It is uncommon but important syndrome because of inceased risk of squamous cell carcinoma of the pharynx and esophagus. The cause of this syndrome is still not clear. A small sized web is treated by correction of anemia, but a large sized one with dysphagia is treated by breakage of web. Recently, we experienced a 41-year-old woman with Plummer-Vinson syndrome. She complained of dysphagia for 10 years. Esophagogram and endoscopic examination showed a hypopharyngeal web and peripheral blood profile was compatible with iron-deficiency anemia. Her symptom improved after endoscopic balloon dilatation of the upper esophageal web.

Rate and Predictive Factors of Rebleeding with Obscure-Overt Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Little information is available on the rate and predictive factors of rebleeding of unknown cause, which is very important in deciding further investigations on obscure-overt gastrointestinal bleeding. The aim of this study was to evaluate the rebleeding rate and related factors in obscure-overt gastrointestinal bleeding patients who revealed normal gastroscopic and colonoscopic findings. METHODS: A total of 69 patients with negative first-line gastroscopy and colonoscopy were enrolled in this study as obscure-overt gastrointestinal bleeding cases. The relationships between rebleeding and clinical characteristics were analyzed retrospectively. RESULTS: The causes of obscure-overt gastrointestinal bleeding were confirmed in 30 cases among the 69 cases. Small bowel tumors (14 cases) were the most common cause, followed by vascular lesions (6 cases). The mean follow-up period was 28 months and rebleeding was noticed in 19 patients (27.5%). Among these rebleeding patients, 14 cases (73.7%) occurred within 6 months. The past experience of previous bleeding was significantly related with rebleeding (p=0.0009). CONCLUSIONS: Close observation and detailed investigations are needed for obscure-overt gastrointestinal bleeding patients with bleeding history, especially during 6 months follow-up.

The Acute Effect of Estrogen on Vascular Responses and Plasma Endothelin-1 Level in Postmenopausal Women

BACKGROUND AND OBJECTIVES: Although estrogen replacement therapy has been associated with reduction of cardiovascular events in postmeno-pausal women (PMW), the underlying mechanisms are pooly understood. Because the beneficial effect of estrogen on vasomotor function and production of vasoconstrictive endothelin-1 may be a mechanism by which cardiovascular disease events are reduced, we accessed the acute effect of estrogen on endothelial dependent, independent vasodilaton and plasma endothelin-1 level and investigated whether the acute effect of estrogen on vascular response is related to reduced circulating plasma endothelin-1 level. MATERIALS AND METHOD: The diameter of the brachial artery at rest, during reactive hyperemia (FMV) and to response to nitroglycerine (NMV) were measured using high resolution ultrasound. Twenty-one PMW, 523 years old, 8 of whom had hypercholesterolemia were included and randomized to receive placebo, conjugated estrogen 2.5 mg and 5.0 mg with one week between each investigation. FMV and plasma endothelin-1 were assessed before and 30 minutes after iv administration of each substance. Sublingual nitroglycerine (NG) was given at the end of each investigation and NMV was measured. RESULTS: FMV and plasma endothelin-1 were not changed after placebo administration. FMV increased sinigicantly only after administration of CE 5.0 mg in healhy PMW and both after administration of CE 2.5 and 5.0 mg in PMW with hypercholesterolemia. NG induced more significant vasodilation after administration of estrogen than placebo in only PMW with hypercholesterolemia. Plasma endothelin-1 level decreased significantly after administration of CE 5.0 mg in PMW with hypercholesterolemia. We could not find direct correlation between increase of FMV and decrease of plasma endothelin-1 level. CONCLUSION: IV administration of conjugated estrogen improves endothelium-dependent vasodilation in PMW and may improve endothelium-independent vasodilation in PMW with hypercholesterolemia. These finding may be partly originated by reduced plasma endothelin-1 level after estrogen administration.

The Relationships between blood pressure and serum lipids in Korean adults

BACKGROUND: Since better understanding of the associations between blood pressure and blood lipids may provide insight into the mechanisms by which hypertension is associated with increased risk of coronary heart disease, this study is aimed to explore the associations of blood pressure with serum lipids, BMI, age, FBS and life style factors. METHODS AND RESULTS: In this study, 20,826 men and 10,209 women were included for the assessment of the cross-sectional relations of blood lipids, BMI, Blood pressure and Life style factors. Stratified analyses and multivariable methods were used to control for potential confounding anthropometric and lifestyle variables. Total cholesterol and Triglyceride levels increased significantly with increasing systolic or diastolic blood pressure in both sexes. Men of 20-29 years old had steeper regression slopes for blood pressure by total cholesterol level than did women of similar age. In men, the association between blood pressure and total cholesterol level decreased with age, whereas in women, no change was observed regarding age. Body mass index modified the relation, whereas smoking, exercise, and alcohol consumption had little influence on the association. HDL cholesterol level had little influence on blood pressure. In the group of age or =40, BMI accounted more. In the group of age < 40, other variables ,besides age and BMI, are suggested to influence more on male hypertension than female hypertension. CONCLUSION: These results provides evidence that there are interrelations between blood pressure, blood lipids and life style factors that may influence the mechanisms of coronary heart disease.